William Robert Wagner, DRNP, LCSW

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F304782 Issued in NY

Practice address

1000 Health Center Road
Kyle Health Center / DHHS/IHS
Kyle, SD 57752

Phone

(917) 626-9011

NPI assigned

Jul 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461888000000",
    "number": "1043219587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER ROAD",
            "address_2": "KYLE HEALTH CENTER / DHHS/IHS",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "57752",
            "telephone_number": "917-626-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER ROAD",
            "address_2": "KYLE HEALTH CENTER / DHHS/IHS",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "57752",
            "telephone_number": "917-626-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "WILLIAM",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DRNP, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2016-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R055430",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "541137",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F304782",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F340615",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Shipe, PHARMD
• Monique Marie Sioux Bob, RN
• Kathleen Rae Thompson, R,N,
• Khiem T Tran, M.D., M.H.A.
• Charlotte Rebecca Vassau, RN
• Susan J Walden, FNP-C
• Meaghan Marie Walker
• Adam O Zayed, PHARMD.
• Paula A Zuccaro, FNP

• Adult Health Nurse Practitioner in Kyle, SD
• Providers in Kyle, SD by specialty
• Adult Health Nurse Practitioner in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.